Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Specialists

Comorbid Conditions

Factors Influencing Duration

Duration depends on the severity of the injury, whether the dominant or nondominant arm is involved, the type of treatment (surgical, nonsurgical), the surgical result, the presence of underlying conditions (e.g., osteoporosis, osteoarthritis, rheumatoid arthritis), and any complications.

Medical Codes

ICD-9-CM:

813.00 -

Closed Fracture of Radius and Ulna, Upper End of Forearm, Unspecified

813.05 -

Closed Fracture of Head of Radius

813.06 -

Closed Fracture of Neck of Radius

813.07 -

Closed Fracture of Other and Unspecified Fractures of Proximal End of Radius (Alone); Multiple Fractures of Radius, Upper End

813.08 -

Closed Fracture of Radius with Ulna, Upper End (Any Part)

813.10 -

Open Fracture of Upper End of Forearm, Unspecified

813.15 -

Open Fracture of Head of Radius

813.16 -

Open Fracture of Neck of Radius

813.17 -

Open Fracture of Other and Unspecified Fractures of Proximal End of Radius (Alone)

813.20 -

Closed Fracture of Shaft of Radius or Ulna, Unspecified

813.21 -

Closed Fracture of Shaft of Radius (Alone)

813.30 -

Open Fracture of Shaft of Radius or Ulna, Unspecified

813.31 -

Open Fracture of Radius (Alone)

813.81 -

Closed Fracture of Radius (Alone), Unspecified Part

813.83 -

Closed Fracture of Radius with Ulna, Unspecified Part

813.91 -

Open Fracture of Radius (Alone), Unspecified Part

813.93 -

Open Fracture of Radius with Ulna, Unspecified Part

Overview

A fracture of the proximal radius (radial head and/or neck) can occur with direct injury to the elbow or indirect injury through the forearm and/or wrist. The elbow joint is very complex but is often described as a hinge joint composed of three bones: two from the forearm (radius and ulna) and one in the upper arm (humerus). These bones work together to allow movement and dexterity of the elbow, forearm, and wrist. The radius moves around the ulna and—with articulation at the distal end of the ulna (radioulnar joint)—allows forearm rotation (supination/pronation or palm up and down). The radius articulates with the humerus (radiocapitellar joint) to allow both forearm rotation and elbow flexion and extension. The ulna is linked to the distal end of the humerus by ligaments and allows for flexion and extension (bending the elbow up and down). The elbow joint is stabilized by ligaments and is in close proximity to the brachial artery and the median, radial, and ulnar nerves.

A fracture of the proximal radius usually occurs as the result of a fall onto an outstretched hand or a direct blow to the lateral elbow. Damage to the other bones of the elbow joint (humerus or ulna fractures and dislocations) or to the soft tissues surrounding the fracture site (tendon, ligament, nerve, and blood vessel injury) may occur simultaneously. One study used x-rays and MRI to look at the association between fracture and ligamentous injury in 24 individuals with a radial head fracture but no tenderness at the elbow joint. It found that 54% of the subjects had medial collateral ligament damage, 80% had lateral ulnar collateral ligament damage, and 50% sustained injury to both the medial and lateral ligaments. Although this is a small study, it does point to a significant association between radial head fracture and ligamentous injury (Itamura).

Proximal radius fractures may be nondisplaced (no misalignment of bones) or displaced (bones not aligned). The Mason classification system is used for both treatment and prognosis. Type I proximal radius fractures involve no displacement and minimal joint (articular) involvement and may be difficult to identify with diagnostic imaging. Type II fractures are those in which the bone fragments have separated by at least 2 mm (displaced); the fragments may be rotated or bent (angulated). Type III fractures (of which are three subclasses) are those in which the head of the radius has broken into many separate fragments (comminuted fracture). A Type IV fracture is a comminuted fracture with elbow dislocation (Morgan).

Type I and many Type II fractures are less severe and may heal well without surgical intervention, but fractures with significant displacement (Types III and IV) will require open reduction-internal fixation (ORIF) to realign the separated fracture fragments. If the proximal radius has become severely displaced or fragmented, excision of the radial head and/or replacement of the proximal radius (radial head arthroplasty) may be necessary.

At the time of injury, proximal radius fractures may become dislocated (fracture-dislocation), with the radial head migrating toward the elbow joint. An Essex-Lopresti fracture is a radial head or neck fracture with dislocation of the distal radioulnar joint (DRUJ) at the wrist and associated rupture of the membrane between the radius and ulna (interosseous membrane).

Incidence and Prevalence: Elbow fractures are fairly common, and 33% include fracture of the radial head or radial neck (Rabin). In adults, olecranon fractures account for 20% of all elbow injuries, and coronoid process fractures occur in 10% to 15% of elbow dislocations (Riego de Dios). Fractures of the proximal radius occur in up to one-third of elbow fractures and dislocations, with radial head fractures the most common type of elbow fracture in adults (Rabin).

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